New Research from HiLabs Shows that 81% of Physicians had Incorrect Entries in Health Insurer Provider Directories

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Mar 16, 2023, 10:07 ET

The study, published in JAMA, is the first to assess provider directory data since the implementation of the No Surprises Act

BETHESDA, Md., March 16, 2023 /PRNewswire/ -- Patients rely on health insurer provider directories to find a doctor in their plan's network. However, 81% of physicians in these directories had inconsistent entries, raising questions about their accuracy, according to a new analysis of health insurer provider directory data published in the Journal of the American Medical Association. The study from researchers at the University of Colorado and HiLabs, makers of an automated data quality platform for health plans, looked at listings for over 440,000 U.S. physicians (nearly half of all the nation's physicians).

Titled "Consistency of Physician Data Across Health Insurer Directories," the study sought to determine if and how the state of provider directories has changed since the No Surprises Act went into effect on January 1, 2022. The Act established protections for patients related to surprise billing and transparency in healthcare. One of the Act's requirements is for health plans to maintain accurate, up-to-date provider directories. While previous studies have investigated provider directory error rates, none have examined the accuracy of provider directories on a national scale. This is also the first such study since the implementation of the No Surprises Act.

Researchers evaluated provider directory data across five large national health plans using technology developed by HiLabs. They found that only 19% of physicians had consistent data on physician address and specialty information across all directories in which they were found. The significant number of inconsistencies was primarily driven by 72% of physicians whose practice location addresses differed from directory to directory. The directories also had inconsistent specialty information for 32% of physicians. The study did not establish which provider's directory had the correct data, only whether data for the same physician differed from directory to directory.

"These findings indicate that there has been little progress in improving provider directory accuracy since implementation of the No Surprises Act," said Neel Butala, MD, Assistant Professor at University of Colorado, who was the lead author of the study. "Beyond surprise billing, inaccurate provider directories can lead to delays in care due to difficulty finding the correct physician, challenges in regulators assessing health plan network adequacy, and misrepresentation of network depth and breadth as consumers select health plans."

"The scope of this problem affecting provider directories is tremendous. This is a long-standing, industry wide dirty data problem and no one actor is responsible for the state of provider directory accuracy" added Amit Garg, CEO of HiLabs "At HiLabs, we're glad to be part of the solution, proactively and rapidly cleaning dirty data in healthcare."

Inefficient and redundant directory reporting mechanisms cost US physician practices a collective $2.76 billion annually. The JAMA study's findings highlight the magnitude of the challenge, and indicate the need to engage both physicians and health plans to address provider directory quality.

HiLabs partners with the nation's leading health plans to help them refine dirty data and comply with the requirements of the No Surprises Act. HiLabs is the only player in the industry to collect and enhance provider directory information using automated ingestion. Its solutions have improved CMS secret shopper-type audits by greater than 25 percent. To learn more about HiLabs, please visit https://hilabs.com/

About HiLabs

HiLabs was founded at Yale with the mission of refining dirty healthcare data. A team of healthcare professionals worked alongside data scientists and AI experts to perfect a platform capable of accurately discovering data patterns and errors in provider, claims, clinical, and value-based care data. HiLabs' AI platform, MCheck, has analyzed over 34 billion health data records covering 24% of the US healthcare population and serves 4 out of the 10 largest health plans and multiple regional plans across the US. For more information, visit http://www.hilabs.com.

SOURCE HiLabs